Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2011
Extracorporeal membrane oxygenator rescue and airborne transportation of patients with influenza A (H1N1) acute respiratory distress syndrome in a Mediterranean underserved area.
Adult respiratory distress syndrome (ARDS) secondary to H1N1 viral infection has been a worldwide medical and organizational challenge. We report our experience with extracorporeal membrane oxygenator (ECMO) rescue and transportation of patients with H1N1 ARDS within an insular and rural Mediterranean area of seven million inhabitants. A 24/7 on-call ECMO team was organized including one anesthesiologist, one cardiac surgeon, and one perfusionist. ⋯ No complications secondary to the transportation means or to the ECMO were reported. Delivery of advanced medical technology can be achieved even in remote and underserved areas presenting geographical barriers. A multidisciplinary mobile ECMO team coordinated with adequate means of transportation could be routinely employed to rescue patients affected with other forms of severe acute hemodynamic and/or respiratory impairment.
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Interact Cardiovasc Thorac Surg · Jun 2011
Should we operate on microscopic N2 non-small cell lung cancer?
Traditionally non-small cell lung cancer (NSCLC) stage N2 is considered as a contraindication for curative resection. We investigated the outcome of patients with microscopic N2 disease, who underwent potentially curative resections. The independent effects of lobectomy vs. pneumonectomy, histology subtype, body mass index (BMI), sex, and PET-scanning were investigated. ⋯ A low N2 survival risk score was associated with increased survival, P=0.001. Resecting microscopic N2 disease in NSCLC may be appropriate in some patients. An N2 survival scoring system may help select patients for surgery, and help evaluate adjuvant and neoadjuvant publications with regard to microscopic N2 disease.
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Interact Cardiovasc Thorac Surg · Jun 2011
Case ReportsA ruptured mature teratoma in which follow-up computed tomography observation at short intervals was useful for a definitive diagnosis.
Rupture of mature mediastinal teratomas occasionally occurs, necessitating prompt surgical treatment. However, the clinical presentation of a ruptured teratoma can resemble that of pneumonia and/or pleuritis. We report a case of mediastinal teratoma rupture, in which follow-up computed tomography (CT) a short-interval after the first CT was useful for definitive diagnosis. ⋯ Eighteen hours later, a repeat CT-revealed an increase in the soft tissue area of the chest wall adjacent to the tumor, which led to the definitive diagnosis of ruptured teratoma, and immediate resection was performed. The histological diagnosis was a mature teratoma, and rupture was confirmed by the high lipase level in the pleural fluid. The patient's postoperative course was uneventful.
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Interact Cardiovasc Thorac Surg · Jun 2011
Case ReportsFirst experience with the ultra compact mobile extracorporeal membrane oxygenation system Cardiohelp in interhospital transport.
In patients with severe cardiopulmonary failure extracorporeal assist devices are to support patients during resuscitation, for transportation, until organ recovery, and as bridge to further therapeutic modalities. We report on our first experience with the new Cardiohelp system for interhospital transfer of cardiopulmonarily compromised patients. The Cardiohelp system was used for transportation and in-house treatment in six male patients with a mean age of 41±17 years. ⋯ A 100% survival was achieved. The portable Cardiohelp system allows location-independent stabilization of cardiopulmonary compromised patients with consecutive interhospital transfer and in-house treatment. The integrated sensors, which register arterial and venous line pressure, blood temperature, hemoglobin as well as SvO(2), greatly alleviate its management and considerably increase safety.
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Interact Cardiovasc Thorac Surg · Jun 2011
Rescue extracorporeal membrane oxygenation in children with refractory cardiac arrest.
We describe our experience with extracorporeal cardiopulmonary resuscitation (CPR) using extracorporeal membrane oxygenation (ECMO) in children with refractory cardiac arrest, and determine predictors for mortality. ECMO support was instituted on 42 children, median age 0.7 years (1 day-17.8 years), median weight 7.05 (range 2.7-80) kg who suffered refractory cardiac arrest (1992-2008). Patients were postcardiotomy (n=27), or had uncorrected congenital heart diseases (n=3), cardiomyopathy (n=3), myocarditis (n=2), respiratory failure (n=3), or had trauma (n=4). ⋯ Age, weight, sex, anatomic diagnosis, etiology (surgical vs. medical) were not significant predictors of poor outcome. Prolonged CPR and high-dose inotropes are significant predictors of mortality. Rescue ECMO support in children with refractory cardiac arrest can achieve acceptable survival and neurological outcomes.